Purpose or Case Report: PURPOSE: Trauma is a leading cause of death and disability in children ages 1-18, with abdominal trauma accounting for a significant patient population. Prompt identification of bowel and mesenteric injury in the setting of blunt trauma and penetrating injuries is important to avoid significant complications that may arise from delayed diagnosis. Spectral Dual-Energy Computed Tomography (DECT) obtains raw data at two energy spectra which by virtue of material decomposition can identify, isolate and or quantify iodine, pure calcium, and uric acid. Multiple image sets can be generated from a single scan allowing both anatomic and material-specific analysis. The use of DECT can improve detection and accurate grading of solid organ injury, aid in defining active hemorrhage, and increase visibility of altered bowel wall enhancement, ischemia, necrosis, and inflammation which provides critical information to inform the course of treatment in emergent settings.
Methods & Materials: MATERIALS AND METHODS: For this project we performed a retrospective review of clinical cases using Spectral DECT (Philips Iqon, Philips Healthcare) in the evaluation of pediatric bowel injuries highlighting the utilization and value-added information of virtual non-contrast images (VNC), virtual mono-energetic images (Mono E), iodine density (ID) and iodine fusion images.
Results: RESULTS: Spectral DECT image sets were advantageous to the demonstration of bowel injuries in children. Iodine maps and iodine fusion images increased conspicuity of bowel hypo- and non-perfusion abnormalities and infarct. Detection of mesenteric injuries were more conspicuous on the virtual low mono-energetic images. Bowel wall disruption and perforation were demonstrated on iodine density and iodine fusion images. Virtual non-contrast and iodine only images aided in the discrimination between bowel wall hematoma and active vascular extravasation.
Conclusions: CONCLUSIONS: The use of spectral DECT at our institution has improved our diagnostic confidence in the evaluation of pediatric traumatic bowel and mesenteric injuries. We propose additional areas of clinical research aimed with the goal to validate and define its role in the pediatric trauma population.